Poor In City To Lose Visiting Nurse Care

For Many Hartford Poor, Visiting Nurses To Visit No More

For 90 years, through two world wars, the Great Depression and various natural disasters, visiting nurses have ministered to Hartford's poorest and neediest residents in their homes.

That will change, beginning Monday.

Citing a cutback in the state reimbursement formula, officials for Visiting Nurse And Home Care Inc. say they no longer can afford to accept new Medicaid patients from poor, crime-ridden neighborhoods. The decision will cut service to nearly all the city's new Medicaid patients who have the virus that causes AIDS or need maternal and infant services.

Medicaid patients in affected neighborhoods will continue to receive services. However, as many as 40 new patients a week could be affected. Many of those are young drug-dependent mothers and their babies, said Judith Welch, associate director of the Hartford branch of Visiting Nurse and Home Care Inc.

The shift will cut the only home health care available to many residents and will place a tremendous burden on other medical providers such as hospitals.

No new Medicaid patients would be accepted in all or part of the city's Frog Hollow, Charter Oak-Zion, Sheldon-Charter Oak, Clay-Arsenal, Northeast and Upper Albany neighborhoods.

Elsewhere in the city -- excluding the South and West ends and a portion of the downtown area -- the private nonprofit health care agency will no longer accept Medicaid referrals for patients who test positive for HIV, the virus that causes AIDS; those needing maternal and infant services and patients requiring intravenous therapy.

"This is what's very difficult. Essentially we are the sole provider who will take care of these babies," said VNA Group Inc. President Margaret J. Cushman.

Cushman justified the decision not to accept new Medicaid patients on economic grounds: because of security costs and the nature of the health and social problems, patient care in the inner city is more costly than in the suburbs. For example, each nurse and home health aide working in a high-crime area must be accompanied by a security escort. The escorts and their radio

equipment cost the agency about $250,000 this year.

At the same time, the state budget adopted in August reduced the maximum amount of reimbursement that had been set by the Commission on Hospitals and Health Care.

"Imposition of the new law ... would result in an annualized deficit for Visiting Nurse and home Care of $1.2 million," Cushman said.

"There is no way VNAHC can sustain this loss," she said.

Hospital and health officials in Hartford wondered how the void created by the proposed cutback would be filled.

Richard Fisher, assistant director of social service for Hartford Hospital said, "We kind of depend on the visiting nurses association for a number of things. I think this is going to have a devastating impact on children, the elderly and poor people in general.

"They are really the only game in town to provide nursing and social services help," he said. "We're very concerned about this."

Fisher anticipated that hospitals would be forced to hold patients longer, unless some suitable home care alternative could be found. Longer stays translate to higher hospital bills.

"A day in the hospital is going to cost a heck of a lot more but we're not going to jeopardize a patient's health when there are no supports in place," he said.

Clara Acosta-Glynn, director of Latinos/as Contra Sida (Latins Against AIDS), estimated that one-half of the 74 AIDS patients in the city that her agency now serves will require home nursing care in the future.

"Most of our clients are Medicaid Title 19. If they're not taking referrals it would be a terrible impact," she said. "I am very surprised they have decided to do that."

About 75 expectant mothers are referred each year to the visiting nurses by a group established to combat infant mortality in the poorest city neighborhoods.

"Wow, that is going to have a devastating effect. We give them a lot of business and they give us a lot of help with high-risk pregnant women," said Judith Kunisch, director of pre-term birth prevention project for Hartford Action Plan on Infant Health.

The North End neighborhoods affected by the cutback in service are those with the highest infant mortality rates, a consequence of premature births, she said.

Officials at St. Francis Hospital and Medical Center's home health agency say they should be able to meet the needs of Medicaid patients in affected neighborhoods discharged from St. Francis and Mount Sinai Hospital. Help would be sought from other home health providers if needed.

"In a nutshell we're going to step in and fill the void the best we can," hospital spokesman Peter Mobilia said.

City Health Director Mark Mitchell said the visiting nurses have provided an effective, cost-effective means of providing health services to poor patients with AIDS and chronic diseases.